2018 -- S 2529

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LC004725

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2018

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Senators Euer, Goldin, Sosnowski, Coyne, and Seveney

     Date Introduced: March 01, 2018

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

1

     SECTION 1. Section 27-18-57 of the General Laws in Chapter 27-18 entitled "Accident

2

and Sickness Insurance Policies" is hereby amended to read as follows:

3

     27-18-57. F.D.A. approved prescription contraceptive drugs and devices.

4

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

5

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

6

amended or effective in this state on or after January 1, 2019, in this state shall provide coverage

7

for all of the following services and contraceptive methods. F.D.A. approved contraceptive drugs

8

and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to

9

mandate or require coverage for the prescription drug RU 486.

10

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

11

applies to this coverage:

12

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

13

product, the contract must include either the original FDA-approved contraceptive drug, device,

14

or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the

15

same definition as that set forth by the Federal Drug Administration.

16

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

17

available or are deemed medically inadvisable, a group or blanket policy shall provide coverage

18

for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based

19

on the determination of the health care provider, without cost-sharing;

 

1

     (iii) Coverage required by this section must include all over-the-counter contraceptive

2

drugs, devices and products approved by the United States Food and Drug Administration when

3

prescribed by a licensed provider, excluding male condoms; and

4

     (iv) Coverage required by this section must include the dispensing of a supply intended to

5

last twelve (12) months at a time to enrollees with a valid prescription, unless a smaller supply is

6

requested by an enrollee or the prescribing provider instructs that the enrollee must receive a

7

smaller supply.

8

     (2) Voluntary sterilization procedures, except that coverage for male sterilization does not

9

apply to high-deductible health plans;

10

     (3) Patient education and counseling on contraception; and

11

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

12

under this section, including, but not limited to, management of side effects, counseling for

13

continued adherence, and device insertion and removal.

14

     (b) A group or blanket policy subject to this section shall not impose a deductible,

15

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

16

to this section.

17

     (c) Except as otherwise authorized under this subsection, a group or blanket policy shall

18

not impose any restrictions or delays on the coverage required under this section.

19

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

20

spouse or domestic partner and covered non-spouse dependents.

21

     (b)(e) Notwithstanding any other provision of this section, any insurance company may

22

issue to a religious employer an individual or group health insurance contract, plan, or policy that

23

excludes coverage for prescription contraceptive methods which are contrary to the religious

24

employer's bona fide religious tenets.

25

     (c)(f) As used in this section, "religious employer" means an employer that is a "church

26

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

27

     (d)(g) This section does not apply to insurance coverage providing benefits for: (1)

28

hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5)

29

Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of

30

bodily injury or death by accident or both; and (9) other limited benefit policies.

31

     (e)(h) Every religious employer that invokes the exemption provided under this section

32

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

33

contraceptive health care services the employer refuses to cover for religious reasons.

34

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

 

LC004725 - Page 2 of 9

1

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

2

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

3

preserve the life or health of an enrollee.

4

     SECTION 2. Section 27-19-48 of the General Laws in Chapter 27-19 entitled "Nonprofit

5

Hospital Service Corporations" is hereby amended to read as follows:

6

     27-19-48. F.D.A. approved prescription contraceptive drugs and devices.

7

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

8

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

9

amended or effective in this state on or after January 1, 2019, in this state shall provide coverage

10

for all of the following services and contraceptive methods. F.D.A. approved contraceptive drugs

11

and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to

12

mandate or require coverage for the prescription drug RU 486.

13

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

14

applies to this coverage:

15

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

16

product, the contract must include either the original FDA-approved contraceptive drug, device,

17

or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the

18

same definition as that set forth by the Federal Drug Administration.

19

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

20

available or are deemed medically inadvisable, a group or blanket policy shall provide coverage

21

for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based

22

on the determination of the health care provider, without cost-sharing;

23

     (iii) Coverage required by this section must include all over-the-counter contraceptive

24

drugs, devices and products approved by the United States Food and Drug Administration when

25

prescribed by a licensed provider, excluding male condoms; and

26

     (iv) Coverage required by this section must include the dispensing of a supply intended to

27

last twelve (12) months at a time to enrollees with a valid prescription, unless a smaller supply is

28

requested by an enrollee or the prescribing provider instructs that the enrollee must receive a

29

smaller supply.

30

     (2) Voluntary sterilization procedures, except that coverage for male sterilization does not

31

apply to high-deductible health plans;

32

     (3) Patient education and counseling on contraception; and

33

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

34

under this section, including, but not limited to, management of side effects, counseling for

 

LC004725 - Page 3 of 9

1

continued adherence, and device insertion and removal.

2

     (b) A group or blanket policy subject to this section shall not impose a deductible,

3

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

4

to this section.

5

     (c) Except as otherwise authorized under this subsection, a group or blanket policy shall

6

not impose any restrictions or delays on the coverage required under this section.

7

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

8

spouse or domestic partner and covered non-spouse dependents.

9

     (b)(e) Notwithstanding any other provision of this section, any insurance company may

10

issue to a religious employer an individual or group health insurance contract, plan, or policy that

11

excludes coverage for prescription contraceptive methods which are contrary to the religious

12

employer's bona fide religious tenets.

13

     (c)(f) As used in this section, "religious employer" means an employer that is a "church

14

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

15

     (d)(g) This section does not apply to insurance coverage providing benefits for: (1)

16

hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5)

17

Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of

18

bodily injury or death by accident or both; and (9) other limited benefit policies.

19

     (e)(h) Every religious employer that invokes the exemption provided under this section

20

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

21

contraceptive health care services the employer refuses to cover for religious reasons.

22

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

23

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

24

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

25

preserve the life or health of an enrollee.

26

     SECTION 3. Section 27-20-43 of the General Laws in Chapter 27-20 entitled "Nonprofit

27

Medical Service Corporations" is hereby amended to read as follows:

28

     27-20-43. F.D.A. approved prescription contraceptive drugs and devices.

29

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

30

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

31

amended or effective in this state on or after January 1, 2019, in this state shall provide coverage

32

for all of the following services and contraceptive methods. F.D.A. approved contraceptive drugs

33

and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to

34

mandate or require coverage for the prescription drug RU 486.

 

LC004725 - Page 4 of 9

1

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

2

applies to this coverage:

3

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

4

product, the contract must include either the original FDA-approved contraceptive drug, device,

5

or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the

6

same definition as that set forth by the Federal Drug Administration.

7

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

8

available or are deemed medically inadvisable, a group or blanket policy shall provide coverage

9

for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based

10

on the determination of the health care provider, without cost-sharing;

11

     (iii) Coverage required by this section must include all over-the-counter contraceptive

12

drugs, devices and products approved by the United States Food and Drug Administration when

13

prescribed by a licensed provider, excluding male condoms; and

14

     (iv) Coverage required by this section must include the dispensing of a supply intended to

15

last twelve (12) months at a time to enrollees with a valid prescription, unless a smaller supply is

16

requested by an enrollee or the prescribing provider instructs that the enrollee must receive a

17

smaller supply.

18

     (2) Voluntary sterilization procedures, except that coverage for male sterilization does not

19

apply to high-deductible health plans;

20

     (3) Patient education and counseling on contraception; and

21

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

22

under this section, including, but not limited to, management of side effects, counseling for

23

continued adherence, and device insertion and removal.

24

     (b) A group or blanket policy subject to this section shall not impose a deductible,

25

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

26

to this section.

27

     (c) Except as otherwise authorized under this subsection, a group or blanket policy shall

28

not impose any restrictions or delays on the coverage required under this section.

29

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

30

spouse or domestic partner and covered non-spouse dependents.

31

     (b)(e) Notwithstanding any other provision of this section, any insurance company may

32

issue to a religious employer an individual or group health insurance contract, plan, or policy that

33

excludes coverage for prescription contraceptive methods which are contrary to the religious

34

employer's bona fide religious tenets.

 

LC004725 - Page 5 of 9

1

     (c)(f) As used in this section, "religious employer" means an employer that is a "church

2

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

3

     (d)(g) This section does not apply to insurance coverage providing benefits for: (1)

4

hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5)

5

Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of

6

bodily injury or death by accident or both; and (9) other limited benefit policies.

7

     (e)(h) Every religious employer that invokes the exemption provided under this section

8

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

9

contraceptive health care services the employer refuses to cover for religious reasons.

10

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

11

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

12

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

13

preserve the life or health of an enrollee.

14

     SECTION 4. Section 27-41-59 of the General Laws in Chapter 27-41 entitled "Health

15

Maintenance Organizations" is hereby amended to read as follows:

16

     27-41-59. F.D.A. approved prescription contraceptive drugs and devices.

17

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

18

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

19

amended or effective in this state on or after January 1, 2019, in this state shall provide coverage

20

for all of the following services and contraceptive methods. F.D.A. approved contraceptive drugs

21

and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to

22

mandate or require coverage for the prescription drug RU 486.

23

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

24

applies to this coverage:

25

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

26

product, the contract must include either the original FDA-approved contraceptive drug, device,

27

or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the

28

same definition as that set forth by the Federal Drug Administration.

29

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

30

available or are deemed medically inadvisable, a group or blanket policy shall provide coverage

31

for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based

32

on the determination of the health care provider, without cost-sharing;

33

     (iii) Coverage required by this section must include all over-the-counter contraceptive

34

drugs, devices and products approved by the United States Food and Drug Administration when

 

LC004725 - Page 6 of 9

1

prescribed by a licensed provider, excluding male condoms; and

2

     (iv) Coverage required by this section must include the dispensing of a supply intended to

3

last twelve (12) months at a time to enrollees with a valid prescription, unless a smaller supply is

4

requested by an enrollee or the prescribing provider instructs that the enrollee must receive a

5

smaller supply.

6

     (2) Voluntary sterilization procedures, except that coverage for male sterilization does not

7

apply to high-deductible health plans;

8

     (3) Patient education and counseling on contraception; and

9

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

10

under this section, including, but not limited to, management of side effects, counseling for

11

continued adherence, and device insertion and removal.

12

     (b) A group or blanket policy subject to this section shall not impose a deductible,

13

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

14

to this section.

15

     (c) Except as otherwise authorized under this subsection, a group or blanket policy shall

16

not impose any restrictions or delays on the coverage required under this section.

17

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

18

spouse or domestic partner and covered non-spouse dependents.

19

     (b)(e) Notwithstanding any other provision of this section, any insurance company may

20

issue to a religious employer an individual or group health insurance contract, plan, or policy that

21

excludes coverage for prescription contraceptive methods which are contrary to the religious

22

employer's bona fide religious tenets.

23

     (c)(f) As used in this section, "religious employer" means an employer that is a "church

24

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

25

     (d)(g) This section does not apply to insurance coverage providing benefits for: (1)

26

hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5)

27

Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of

28

bodily injury or death by accident or both; and (9) other limited benefit policies.

29

     (e)(h) Every religious employer that invokes the exemption provided under this section

30

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

31

contraceptive health care services the employer refuses to cover for religious reasons.

32

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

33

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

34

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

 

LC004725 - Page 7 of 9

1

preserve the life or health of an enrollee.

2

     SECTION 5. Chapter 42-12.3 of the General Laws entitled "Health Care for Children and

3

Pregnant Women" is hereby amended by adding thereto the following section:

4

     42-12.3-3.1. Medical assistance expansion for women -- Full year coverage for

5

contraception.

6

     (a) Within one hundred eighty (180) days from January 1, 2019, the department of human

7

services shall develop and implement a system by which the Medicaid program reimburses for,

8

and Medicaid pharmacies, health care providers, and pharmacy benefit managers dispense:

9

     (1) Twelve (12) months of prescription contraception at a time to enrollees with a valid

10

prescription, unless a smaller supply is requested by an enrollee or the prescribing provider

11

instructs that the enrollee must receive a smaller supply.

12

     (b) This section shall apply to all Medicaid programs, including managed care.

13

     (c) The department of human services may issue rules and regulations to implement the

14

provisions of this section.

15

     (d) This section shall serve as legislative approval for any Medicaid State Plan

16

Amendment that is required by the Centers for Medicare and Medicaid Services to implement this

17

section.

18

     SECTION 6. This act shall take effect upon passage.

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LC004725

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LC004725 - Page 8 of 9

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

1

     This act would require every individual or group health insurance contract effective on or

2

after January 1, 2019, to provide coverage to the insured and the insured's spouse and dependents

3

for all FDA-approved contraceptive drugs, devices and other products, voluntary sterilization

4

procedures, patient education and counseling on contraception and follow-up services as well as

5

Medicaid coverage for a twelve (12) month supply for Medicaid recipients.

6

     This act would take effect upon passage.

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LC004725

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LC004725 - Page 9 of 9